Deep learning risk assessment models for predicting progression of radiographic medial joint space loss over a 48-MONTH follow-up period.
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ABSTRACT:
SUBMITTER: Guan B
PROVIDER: S-EPMC7137777 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Quantification of joint space width of the ankle could provide information essential to evaluate the effects of potential disease-modifying agents and adverse effects of devices intended to ameliorate osteoarthritis elsewhere in the lower extremity. Current methods require proprietary software or have not been well validated; our purpose was to develop and assess the reliability of a digital joint space width quantification method using public access software. We studied 95 patients, asymptomatic in the ankles and without history of ankle trauma, but with symptomatic medial knee osteoarthritis, participating in an ongoing longitudinal trial. Weightbearing anteroposterior radiographs of the ankle and supine radiographs of the pelvis were assessed, and the narrowest medial and lateral tibiotalar joint space widths and hip joint space widths were measured using Image J software (US NIH, Bethesda, MD). Medial joint space widths were 2.56 +/- 0.50 and 2.55 +/- 0.48 mm, and lateral joint space widths were 2.45 +/- 0.55 and 2.44 +/- 0.52 mm, for right and left ankle, respectively. Coefficients of variation for repeat measurements by the same observer were 1.13% and 4.5%, and by different observers 7.30% and 7.27%, for medial and lateral joint space widths, respectively. Men had wider joint space widths than women when accounting for height. Joint space width of the ankle correlated with the joint space width of the hip and with height and weight, but not with age.
| S-EPMC2706360 | biostudies-literature
Project description:ObjectiveTo evaluate the rate of radiographic structural progression in the sacroiliac (SI) joints in patients with radiographic or nonradiographic axial spondyloarthritis (SpA), and to determine factors predisposing to such progression, over 2 years.MethodsPatients with recent-onset axial SpA (from the Devenir des Spondyloarthropathies Indifferérenciées Récentes cohort) were assigned a radiographic SI joint score according to the modified New York criteria. Demographic characteristics, smoking status, HLA-B27 positivity, inflammation on magnetic resonance imaging (MRI) of the SI joints, disease activity, and treatment were investigated as potential predisposing factors. The main analysis consisted of the evaluation of the switch from nonradiographic to radiographic axial SpA, but other definitions of radiographic progression were also evaluated.ResultsOf the 708 patients enrolled, 449 had baseline and 2-year pelvic radiographs. Of these patients, 47% were men. Their mean?±?SD age was 34?±?9 years, 61% were B27 positive, and 37% had inflammation of the SI joints on MRI. The percentages of patients who switched from nonradiographic to radiographic axial SpA (4.9% [16 of 326]) and from radiographic to nonradiographic axial SpA (5.7% [7 of 123]) were low. The mean?±?SD change in the total SI joint score (range 0-8) was small (0.1?±?0.8) but highly significant (P?<?0.001). The potential baseline predisposing factors for meeting the modified New York criteria in the multivariate analysis were current smoking, HLA-B27 positivity, and inflammation of the SI joints on MRI, with odds ratios of 3.3 (95% confidence interval [95% CI] 1.0-11.5], 12.6 (95% CI 2.3-274), and 48.8 (95% CI 9.3-904), respectively.ConclusionOur findings suggest that structural progression does exist in early SpA, but it is quite small and observed in a small number of patients, and that environmental (smoking status), genetic (HLA-B27 positivity), and inflammation (inflammation of the SI joints on MRI) markers might be independent predisposing factors for progression.
| S-EPMC5129505 | biostudies-literature
Project description:PURPOSE: The purpose of the study was to relate magnetic resonance imaging (MRI) features at baseline with radiographically determined joint space narrowing (JSN) in the medial compartment of the knee after 2 years in a group of patients with symptomatic osteoarthritis at multiple joint sites. MATERIALS AND METHODS: MRI of the knee and standardized radiographs were obtained at baseline and after 2 years in 186 patients (81% female; aged 43-76 years; mean 60 years). MRI was analyzed for bone marrow lesions, cysts, osteophytes, hyaline cartilage defects, joint effusion, and meniscal pathology in the medial compartment. Radiographs were scored semiquantitatively for JSN in the medial tibiofemoral joint using the Osteoarthritis Research Society International (OARSI) atlas. Radiological progression was defined as > or =1 grade increase. Associations between baseline magnetic resonance (MR) parameters and subsequent radiographic JSN changes were assessed using logistic regression. Relative risk (RR) was then calculated. RESULTS: Radiographic progression of JSN was observed in 17 (9.1%) of 186 patients. Eleven patients had a Kellgren and Lawrence (KL) score of > or =2. A significant association was observed between all patients and meniscal tears (RR 3.57; confidence interval (CI) 1.08-10.0) and meniscal subluxation (RR 2.73; CI 1.20-5.41), between KL < 2 and meniscal subluxation (RR 11.3; CI 2.49-29.49) and KL > or = 2 and meniscus tears (RR 8.91; CI 1.13-22.84) and radiographic JSN 2 years later. Follow-up MR in 15 of 17 patients with progressive JSN showed only new meniscal abnormalities and no progression of cartilage loss. CONCLUSION: Meniscal pathology (tears and/or meniscal subluxation) was the only MRI parameter to be associated with subsequent radiographic progression of JSN in the medial tibiofemoral compartment on a radiograph 2 years later, as assessed by the OARSI score.
| S-EPMC2491711 | biostudies-other
Project description:BACKGROUND:No consensus is available regarding the best method for measuring tibiofemoral joint space width (JSW) on radiographs to quantify joint changes after injury. Studies that track articular cartilage thickness after injury frequently use patients' uninjured contralateral knees as controls, although the literature supporting this comparison is limited. PURPOSE:(1) To compare JSW measurements using 2 established measurement techniques in healthy control participants and (2) to determine whether the mean JSW of the uninjured contralateral knee in a cohort with anterior cruciate ligament (ACL) reconstruction is different from that obtained from a true control population. STUDY DESIGN:Cohort study (diagnosis); Level of evidence, 2. METHODS:Medial and lateral JSWs were measured on standardized, bilateral, semiflexed metatarsophalangeal positioning, posteroanterior radiographs of 60 healthy individuals (26 females; mean ± SD age, 25 ± 6.2 years; no history of knee injury) via 2 published techniques: a computerized surface-delineation method (surface-fit method) and a manual digitization method (midpoint method). Bland-Altman method was used to examine the agreement between JSW measurements obtained with the 2 methods and to examine the agreement between measurements obtained on left and right knees within a participant for each measurement method. Within- and between-participant variance components and intraclass correlation coefficients (ICCs) were computed for JSW measurements corresponding to each method. Two-sample t tests were used to compare the surface-fit method measurements of mean JSW of the true control group (n = 60) with the previously published mean JSW measurements from the Multicenter Orthopaedics Outcomes Network (MOON) nested cohort of 262 contralateral uninjured knees 2 to 3 years after ACL reconstruction. RESULTS:For JSW in the medial compartment, the surface-fit method had lower within-participant interknee variability (?2within, 0.064; 95% CI, 0.04-0.09) compared with the midpoint method (?2within, 0.28; 95% CI, 0.20-0.43) and a higher ICC (0.93 vs 0.65; P < .001). Lateral JSW values were similar for the surface-fit method (?2within, 0.27; 95% CI, 0.18-0.43) and the midpoint method (?2within, 0.20; 95% CI, 0.14-0.31), with ICCs of 0.75 and 0.77, respectively (P = .80). With the surface-fit method, mean JSW measurements of the medial and lateral compartments of a control population were not significantly different from the contralateral uninjured knees of patients after ACL reconstruction. CONCLUSION:For measuring medial JSW, the surface-fit method was less variable across knees within a participant than the midpoint method, as evidenced by larger ICCs and lower interknee variability. For measuring lateral JSW, the 2 methods were similar. The JSW measurements of uninjured contralateral knees of patients with ACL reconstruction at 2 to 3 years postsurgery were not significantly different from those of a cohort of healthy control participants. Future work should be performed to demonstrate the validity of these methods for documenting change over time in the ACL-reconstructed knee.
| S-EPMC5624356 | biostudies-literature
Project description:OBJECTIVES:To verify the incidence of facetary and low back pain after a controlled medial branch anesthetic block in a three-month follow-up and to verify the correlation between the positive results and the demographic variables. METHODS:Patients with chronic lumbar pain underwent a sham blockade (with a saline injection) and then a controlled medial branch block. Their symptoms were evaluated before and after the sham injection and after the real controlled medial branch block; the symptoms were reevaluated after one day and one week, as well as after one, two and three months using the visual analog scale. We searched for an association between the positive results and the demographic characteristics of the patients. RESULTS:A total of 104 controlled medial branch blocks were performed and 54 patients (52%) demonstrated >50% improvements in pain after the blockade. After three months, lumbar pain returned in only 18 individuals, with visual analogue scale scores >4. Therefore, these patients were diagnosed with chronic facet low back pain. The three-months of follow-up after the controlled medial branch block excluded 36 patients (67%) with false positive results. The results of the controlled medial branch block were not correlated to sex, age, pain duration or work disability but were correlated with patient age (p<0.05). CONCLUSION:Patient diagnosis with a controlled medial branch block proved to be effective but was not associated with any demographic variables. A three-month follow-up is required to avoid a high number of false positives.
| S-EPMC4129553 | biostudies-literature
Project description:Radiographic evaluation of preoperative joint space width is believed important to predict the long-term results of osteotomy. We asked whether joint space width differs in the supine and standing positions in patients with Crowe Type-1 osteoarthritis (OA) secondary to developmental dysplasia of the hip (DDH). Joint space width was measured in the supine and standing positions in 146 women and 16 men (231 hips) with OA. Subjects had a mean age of 46.7 years (range, 22-59 years). Differences were seen on radiographs in joint space width between supine (2.35 +/- 1.65 mm; range, 0.1-6.2 mm) and standing (2.04 +/- 1.78 mm; range, 0.0-5.9 mm). In 27 of 172 hips with greater than 1 mm joint space in the supine position, joint space width was decreased by greater than 1 mm in the standing position. To evaluate preoperative joint space width in patients scheduled for osteotomy, radiographs should be obtained with the patient in the standing position.Level IV, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.
| S-EPMC2493015 | biostudies-other
Project description:Minimally invasive surgery (MIS) represents one of the most innovative surgical treatments of hallux valgus (HV). However, long-term outcomes still remain a matter of discussion within the orthopaedic community. The purpose of this longitudinal prospective study was to evaluate radiographic and functional outcomes in patients with mild-to-severe HV who underwent Reverdin-Isham and Akin percutaneous osteotomy, following exostosectomy and lateral release.Eighty patients with mild-to-severe symptomatic HV were treated by MIS. Clinical evaluation was assessed preoperatively, as well as at 3 and 12 months after surgery and at final follow-up of 48 months, using the American Orthopaedic Foot and Ankle Society (AOFAS) hallux grading system. Patient satisfaction and complications were recorded. Computer-assisted measurement of antero-posterior radiographs was taken preoperatively, as well as at 3 and 12 months after surgery and at 48-month follow-up, analysing the intermetatarsal angle (IMA), the hallux valgus angle (HVA), the distal metatarsal articular angle (DMAA) and the tibial sesamoid position. Also, the bridging bone/callus formation was evaluated at the different radiographic follow-ups, while the articular surface congruency and the metatarsal index were calculated only preoperatively and at the last follow-up. Patient satisfaction was assessed using the visual analogue score (VAS). Statistical analysis was carried out using the paired t test. Statistical significance was set at p?<?0.05.The mean AOFAS score was 87.15 points at the final follow-up of 48 months, and the VAS score was 8.35/10. The post-operative radiographic assessments showed a statistically significant improvement compared with preoperative values. The mean corrections of each angular value at the last follow-up were as follows: IMA 3.90°, HVA 12.50°, DMAA 4.72° and a tibial sesamoid position of 1.10. The articular surface was congruent in 77 (96.25%) cases and incongruent only in 3 (3.75%). The complete healing of the osteotomies was achieved in all series at 3-month follow-up. However, the results obtained in the correction of the severe HV deformities were less encouraging.Minimally invasive surgery with Reverdin-Isham and Akin percutaneous osteotomy, in combination with previous exostosectomy and subsequent lateral soft-tissue release, is a safe, effective and reliable procedure for correction of mild-to-moderate HV. However, it requires a long learning curve because of the inherent difficulty of the mixed different surgical procedures.ClinicalTrials.gov PRS Protocol Registration and Results System: NCT02886221.
| S-EPMC5139107 | biostudies-literature
Project description:Torsional malalignment was detected in subjects with medial knee osteoarthritis (KOA) but few studies have reported the effect of torsional deformity on knee joint loads during walking. Therefore, this study examined the relationships between lower limb torsional alignments and knee joint loads during gait in people with symptomatic medial KOA using cross-sectional study design. Lower limb alignments including tibial torsion, tibiofemoral rotation and varus/valgus alignments in standing were measured by EOS low-dose bi-planar x-ray system in 47 subjects with mild or moderate KOA. The external knee adduction moment (KAM), flexion moment (KFM) and the KAM index which was defined as (KAM/ (KAM+KFM)*100) during walking were analyzed using a motion analysis system so as to estimate the knee loads. Results revealed externaltibial torsion was positively associated with KAM in subjects with moderate KOA (r = 0.59, p = 0.02) but not in subjects with mild KOA. On the contrary, significant association was found between knee varus/valgus alignment and KAM in the mild KOA group (r = 0.58, p<0.001) and a sign of association in the moderate KOA group (r = 0.47, p = 0.08). We concluded tibial torsion and knee varus/valgus mal-alignments would be associated with joint loading in subjects with moderate medial KOA during walking. Radiographic severity might need to be considered when using gait modification as a rehabilitation strategy for this condition.
| S-EPMC8301625 | biostudies-literature
Project description:BACKGROUND: Following the World Health Organization Forum in November 2007, the Beijing Declaration recognized the importance of food safety along with the rights of all individuals to a safe and adequate diet. The aim of this study is to retrospectively analyze the patterns in food alert and recall by countries to identify the principal hazard generators and gatekeepers of food safety in the eleven months leading up to the Declaration. METHODS: The food recall data set was collected by the Laboratory of the Government Chemist (LGC, UK) over the period from January to November 2007. Statistics were computed with the focus reporting patterns by the 117 countries. The complexity of the recorded interrelations was depicted as a network constructed from structural properties contained in the data. The analysed network properties included degrees, weighted degrees, modularity and k-core decomposition. Network analyses of the reports, based on 'country making report' (detector) and 'country reported on' (transgressor), revealed that the network is organized around a dominant core. RESULTS: Ten countries were reported for sixty per cent of all faulty products marketed, with the top 5 countries having received between 100 to 281 reports. Further analysis of the dominant core revealed that out of the top five transgressors three made no reports (in the order China > Turkey > Iran). The top ten detectors account for three quarters of reports with three > 300 (Italy: 406, Germany: 340, United Kingdom: 322). CONCLUSION: Of the 117 countries studied, the vast majority of food reports are made by 10 countries, with EU countries predominating. The majority of the faulty foodstuffs originate in ten countries with four major producers making no reports. This pattern is very distant from that proposed by the Beijing Declaration which urges all countries to take responsibility for the provision of safe and adequate diets for their nationals.
| S-EPMC2556336 | biostudies-literature
Project description:BackgroundThe duration of protection afforded by coronavirus disease 2019 (Covid-19) vaccines in the United States is unclear. Whether the increase in postvaccination infections during the summer of 2021 was caused by declining immunity over time, the emergence of the B.1.617.2 (delta) variant, or both is unknown.MethodsWe extracted data regarding Covid-19-related vaccination and outcomes during a 9-month period (December 11, 2020, to September 8, 2021) for approximately 10.6 million North Carolina residents by linking data from the North Carolina Covid-19 Surveillance System and the Covid-19 Vaccine Management System. We used a Cox regression model to estimate the effectiveness of the BNT162b2 (Pfizer-BioNTech), mRNA-1273 (Moderna), and Ad26.COV2.S (Johnson & Johnson-Janssen) vaccines in reducing the current risks of Covid-19, hospitalization, and death, as a function of time elapsed since vaccination.ResultsFor the two-dose regimens of messenger RNA (mRNA) vaccines BNT162b2 (30 μg per dose) and mRNA-1273 (100 μg per dose), vaccine effectiveness against Covid-19 was 94.5% (95% confidence interval [CI], 94.1 to 94.9) and 95.9% (95% CI, 95.5 to 96.2), respectively, at 2 months after the first dose and decreased to 66.6% (95% CI, 65.2 to 67.8) and 80.3% (95% CI, 79.3 to 81.2), respectively, at 7 months. Among early recipients of BNT162b2 and mRNA-1273, effectiveness decreased by approximately 15 and 10 percentage points, respectively, from mid-June to mid-July, when the delta variant became dominant. For the one-dose regimen of Ad26.COV2.S (5 × 1010 viral particles), effectiveness against Covid-19 was 74.8% (95% CI, 72.5 to 76.9) at 1 month and decreased to 59.4% (95% CI, 57.2 to 61.5) at 5 months. All three vaccines maintained better effectiveness in preventing hospitalization and death than in preventing infection over time, although the two mRNA vaccines provided higher levels of protection than Ad26.COV2.S.ConclusionsAll three Covid-19 vaccines had durable effectiveness in reducing the risks of hospitalization and death. Waning protection against infection over time was due to both declining immunity and the emergence of the delta variant. (Funded by a Dennis Gillings Distinguished Professorship and the National Institutes of Health.).
| S-EPMC8781317 | biostudies-literature